Saturday, November 10, 2007

"fall from social grace"

We seem to be working within a particular continuum. For the past two weeks we have been looking at, at scratching our heads over, Autism and the complex nuances of the vast spectrum. From out readings and discussions it seemed that we could contain the spectrum with in the poles of low-functioning (borderline mentally retarded) Autism and high-functioning Aspergers. However, this week we discover there is another closely related disorder, Capgras. The similarities between Capgras and Autism are striking in many respects. The dysfunctional workings of the amygdala, a more general defect in the orbitofrontal cortex, resulting in lack of theory of mind, disturbed face recognition or recognition of people in general, shortcomings in emotional processing, and a “fall from social grace.” This makes me wonder if the Autistic spectrum should be opened up a little more to include Capgras. Or is Capgrass an example of how we can break apart the Autistic spectrum and organize the continuum? This also makes me consider the usefulness of the spectrum. Should it stay in its ambiguous state or be shaped a bit better?

The Hirstein, Damasio, and Powers reading all spoke on the intricacies of theory of mind, emotion, and decision-making. I found the connections between these brain functions to be surprising at first yet in the obvious. Having theory of mind makes it possible for a person to understand the perspective of others. Knowing this from this weeks reading on Capgras and previous readings in Autism, it makes sense that without a theory of mind people have no social tact. We also see that dysfunction in emotional responses and recognition also plays into theory of mind and behavior. Apart of the inability to recognize people is because one cannot draw upon an emotional connection to that person. Because those with Capgas do not have this emotional connection, and do not understand the perspectives of others they live in this detached world. A lot like those with Autism. They confabulate the world around them, because they have faulty emotional ties, which make their actions in the real world inappropriate and wrong.

Mark, Gage, and Elliot, all had the fundamental aspects of brain functioning intact, however we see that this does no mean that they are fully intact people. Capgras eroded a huge part of their personalities and thereby altered their behavior by taking away particular higher brain functions. Thanks to Mark, Gage, and Elliot’s dissociation, we see how essential to survival it is to have ones personality in place. Because these men were not able to recognize their family members, have appropriate emotional responses, and confabulated much of their world, they had no feeling of self anymore. They knew about their live, were conscious of the fact they had families, jobs, etc, however they are described as not having emotional connection to their lives. Mark knows he has a sister, yet her does not recognize and feel connected to Karin. I believe, and as was touched in the reading, that this emotional connection to ones life and self is essential in ones personality. We also see in Elliot that with out his personality he made horrible business decisions where he ended up in bankruptcy. What the cases of Capgras boil down to is a debate about the core of a person. What really makes a person? Damasio asks the important question when talking about Gage, “Is it fair to say that his soul was diminished, or that he had lost his soul?”

Understanding Motivation

Motivation is simply fascinating—what drives us, what “makes us tick.” Prior to this course I had never thought of motivation as being a function of the brain outside of a very “hunter/gatherer” sense. I understood that people wanted things foremost on a basic level like food and water (incentives) because they were necessary for survival, but I never really understood why people wanted other things like material possessions (secondary incentives) that weren’t evolutionarily “programmed” as a means to survive.

The use of dopamine in the brain was most interesting. I often hear the word dopamine thrown around, usually associated with drugs. Even in the movie Super Size Me, it was proposed that fast food raised dopamine levels in the brain and therefore had “addictive properties,” that would cause a continued consummation of the product.

I always thought dopamine simply caused a sense of euphoria—in essence, it made you feel good. The fact this is incorrect, that dopamine is rather was motivates you to obtain incentives is quite intriguing. I can’t say that I fully understand how pleasure centers work. If dopamine is what makes you want, then what exactly makes you feel pleasure? What occurs in the brain that causes satisfaction?

It’s interesting to read about motivation in the context of The Echo Maker. A woman, whose brother suffers severe brain injury, is driven to determine what exactly happened to him. I think the closeness to her brother is a great factor in what drives her here, had they not had such a strong relationship prior to the accident, would she still be so consumed in what went wrong? I think it’s logical to assume that what motivates us differs on an individual level which causes me to recall the idea of nature/nurture and being wired for certain behaviors.

Remembering Zatesky and Skloot who still had their motivation intact, whose motivation became their lives because their lives had become fragmented and piecing what they had lost back together was the incentive. But I think even prior to their brain insults they were determined people in general, it was part of their persona.

I think it’d be interesting to determine how much of us is wired toward certain motivations as opposed to others; and how much of that is predetermined by the critical time during our childhood where we are more susceptible to wiring.

"In the Neighborhood of Benevolence and the Front Part of Veneration"

You dream about someone special in your life, someone you are close to or love. In the dream, the person hurts you, or behaves unexpectedly, does something shocking. The next time you see that person, you look at her or him a little differently. It was just a dream, but you can't help feeling like the person in front of you is somehow changed.

This, I imagine, is sort of what misidentification syndromes such as Capgras must feel like. I read Part One of The Echo Maker before tackling the other readings this week and wondered how different the experience is now than if I had read it before taking our Narrative Neuropsychology class. Four months ago I still would have been fascinated by Mark Schluter's brain disorder, but I think I would have been more anxious to find out the secrets behind the car crash than the secrets of Mark's mind. But maybe that's just a confabulation. I couldn't help noticing how many parts of the text reminded me of other people and situations we've read about: page 36, where Karin asked, "If he can say a word, it must mean something, right?" called to mind dementia and Alzheimer's patients who sing, and Sacks's patients with Parkinson's who could be driven to speech through music lyrics; Mark's first nonsensical phrases reminded me of Skloot's occasional trouble with word retrieval, and Mark's profanity brought to mind Tourette's patients; page 59, when Mark asked if he were asleep, reminded me of Zasetsky; page 78, as Mark considered what it meant to be related, made me think of Zeke's feelings of gladness at not having any siblings; page 80, where Mark "seemed for a moment about to break free, to know her," had me considering the relationship between Capgras and memory. It's no wonder, given what we've learned in our readings about the interconnectedness of the brain, that one disorder would have whispers of another.

Richard Powers is also examining issues of identity and labels that we've touched on in class. When Karin, on p. 56, spotted a bird she couldn't name, Powers wrote "Names would only have obliterated the thing." This is like losing sight of the human once he is diagnosed with a certain disease, what Sacks works against. This is reiterated on p. 71, when Karin says of the attendant Barbara "She just sees you, sees whoever is in front of her." And Daniel meditates because it makes him "disidentified," a rather ironic thing to say to a person who is the misidentified victim of her brother's Capgras.It is revealed throughout Part One that Karin has changed, or hopes she has changed; doesn't want to be seen as the same person she was. Perhaps that's behind Mark's Capgras: The sister in front of him isn't the woman he remebered. It's also common, when around someone sick or injured, to behave in a way that differs from usual; maybe Capgras sufferers react to this. And besides my example of the dream at the beginning of this blog, we all have little Capgraslike moments in our lives, like on page 93, when Daniel and Karin argue, "And, for a minute, he turned foreign."

If we were all to go crazy, we wouldn't go the same way, and sometimes I amuse myself by thinking of the most entertaining ways friends or colleagues could demonstrate that they've lost it, based on their unique personalities. I thought of this as I read about disinhibition in Brain Fiction. As with the Powers novel, this reading also tied together different disorders, such as autism, Tourette's, and the confabulation disorders. It all leaves me wondering if Capgras and the other misidentification syndromes are mainly problems of perception, memory, or emotional response, or a combination of all three? If, in Capgras, the loved one isn't recognized because the expected emotional response is missing, where did it go? If emotions are just bits of our brains that can be erased by a bonk on the head, what does that say about who we are and what love is? And do we really want to know?

The more I read for this class, the less I believe in psychology at all. The misidentification syndromes seem on the surface to have a psychological basis, but in truth they do not; and I wonder how many people in the past, like Phineas Gage and Elliot described in the Damasio reading, changed after brain injury or illness and were believed to be acting out psychologically--reacting to the trauma of sickness and recovery--rather than altered physically? I enjoyed Damasio's style and, as he described Elliot, compared him to Sacks. He didn't make himself a character in Elliot's story, as Sacks would have done had he written about this patient, but Damasio still gave a nice description of the man behind the illness. Some things I would have liked to know sooner, such as Elliot's own perception of his changed life, but generally thought Damasio was thorough, clear, and compelling. The lack of records about Gage's condition--specifically, as mentioned on p. 51, emotional defects following his accident--reinforce the importance of detailed narratives such as those by Luria, Sacks, Skloot, etc.

A final comment on The Echo Maker: "But she's still sexy as a pay channel" is the best line I've read in a long time.

Friday, November 9, 2007

Mental Deafness: Confabulation, (Mis)Identity, and Reality

This week's readings focused on the theme of confabulation, the accompanying mental scars, and the effects on both the afflicted and their doctors, families, and friends. As Hirstein illuminates in Chapter 5 of Brain Fiction, confabulators display certain traits: orbitofrontal damage, a lack of embarrassment or consideration of others' feelings (edging toward the sociopathic) and a dogged adherence to their claims of "impostors" replacing their loved ones, even in the face of all explanations and facts. (We've all heard about the horrible things that people can do and wondered how someone "normal" could go that badly wrong -- this offers a possibility of argument that sociopaths really do have a different chemical composition, mental defect, or otherwise faulty wiring that leads them to plan and execute acts unfathomable to the average person -- Hitler, Pol Pot, etc.) But while Capgras' syndrome has been meticulously charted in neural terms and doctors can point to the roughly accurate areas of where trauma has occurred, it has also to do with something that cannot yet be fully assembled and picked apart (despite the best efforts of neurologists) -- emotion.

As we've seen in our readings from LeDoux, he is constantly attempting to define emotion solely on the basis of gross neural circuitry and which synapses fire where. While it's true that every operation for humans, consciously or unconsciously, filters back to the "computer in the cranium," this is understandably met with a great deal of resistance when getting into subjects considered more ephemeral, such as emotion, the soul, and innermost fears and desires. As mentioned in The Echo Maker, patients with Capgras have an emotional link severed, and do not automatically access the inherent database of memories, emotions, thoughts, and reactions that, for them, their "real" loved ones would surely activate. As Hirstein explores, the sight of a familiar and much-loved face has much more impact on us than the sight of a stranger. If we see someone we know and care about, our brains activate good memories, pleasant feelings, and the remembrance of experiencing love to reinforce the basic perception of a person that our optic nerves are transmitting: this is a close friend or family member, not an empty automaton, and we know this because we have positive identification and feelings for them. Yet this is precisely what patients with Capgras syndrome lack, and it is this that leaves them to believe they are left alone in a world of impostors.

The Echo Maker explores this issue from both a scientific and humanistic perspective. Unlike Margot Livesey, Richard Powers is clearly writing for both audiences -- scientists and the general public -- and makes sure to enrich his novel with the neuroanatomic prerequisites and manifestations of the syndrome in addition to the effect that his sufferer, Mark Schluter, has on friends and family. We can sympathize with Karin, who is trying desperately to take care of him, and envisioning ourselves in her position is wrenching -- not only has her brother almost lost his life and now requires long-term care, he refuses to even recognize her or be grateful for her presence, because he is convinced that she is someone else. The contortions that our brains can put us through are downright frightening, and yet again raises the question of what reality constitutes. Clearly, Mark has an incorrect idea that Karin is a clone of herself, but for him, it makes perfect and unshakeable sense, and although he might have departed from the mainstream, his life is as informed and his motivations as determined for him as they are for anyone else -- we can only act and react according to what our brains tell us is unshakeably true. Mark cannot live in Karin's reality because he is convinced, on the same level that we are sure of ourselves and who we are, that it is invalid. We can pretend to live in a fantasy world, but quickly run into conflicts with our notions of reality not matching up to everyone else's; besides, it can land us in Bellevue and however much we complain about the food here, it's undoubtedly much worse there.

But that's just the question. We see confabulation as lying; what the patient expresses as reality and what we know from empirical research or evaluation simply do not match up. They will not be convinced otherwise, however; how would you take it if a researcher came up to you and told you that your reality was entirely fabricated and things were much different than you instinctively knew? You'd take it badly, of course, and offer a constant parade of excuses and explanations as to why things were in fact the way you knew them to be. If the patient lacks the awareness or the intention to deceive, and is in fact following their brain's preconceived constructs of reality (as erroneous as they might be) can you really call it lying? Can we even trust our brains? What in the heck are all of us doing? We don't lie about our fundamental surroundings because we have the inherent assumption that they are true, and the same goes for the Capgras' patient. They speak the "truth" for them, which becomes a distortion and paranoia for us because of the different channels mapped by our brains.

Mentally "sound" patients know they are sane because their ideas and precepts match up with everyone else's; that good ol' peer pressure theory back to work. If both you and someone else agree where the wall is, you'll steer your route through your physical space to avoid walking into it; you have the same perceptions and the same mental "channel." The Capgras' sufferer is like that old electronic toy that just kept backing up and hitting the wall again; their reality is out of sync with everyone else's and they are being told that what they know (never mind what subconscious circuits aren't working) is completely wrong. They are in a universe completely different from what they think and perceive to be true, and they are swimming upstream while believing that their real family and friends are being kept from them, most likely through a malicious conspiracy on the part of the doctors -- can they trust these people to heal them? Sounds pretty isolating and frightening to me.

We as readers can sympathize with both the patient and their families/friends, and, like Karin Schluter, we'd be in desperate desire for a cure. Is that what neuropsychology is after all -- altering reality, one brain at a time? Timothy Leary isn't even involved.

Sunday, November 4, 2007

Opening Up

This week’s reading primarily focused on autism, a continuation of the themes of last week. However, both weeks have also emphasized emotions: to what extent someone on the autistic spectrum can experience emotions, how we live with the choices our emotions seem to make for us, and, in the case of the LeDoux reading, what the nature of emotions really is.

I don’t know about anyone else’s take on the assigned reading of this week, but I feel as though emotions are an even grayer area than before I started the reading! True, the reading explores human connectivity and emotions in new and deep ways. But it seems to get so tangled when it all comes together. LeDoux talks about how a “pattern of inputs…biases us more toward an open and accepting mode of processing…” He tells us that, “The net result in working memory is the feeling of love.” While there is surely no elegant way to describe love in technical terms, I feel as though I’d much rather leave it nebulous than have it become a bias that is a result of “a pattern of inputs.”

All of this week’s LeDoux reading was interesting. From the credibility problem and the idea of finding a way around it, to his description of a processing approach for studying emotions, to the studies of people with damage to their amygdalae, to the discussion of wanting to study voles because they mate for life—all of these things fascinated me. And perhaps in a technical sense they help approximate where our emotions, conscious and unconscious, come from. But in a purely visceral way (and I know, here I am calling upon the visceral in a discussion of the visceral!), they seem to fall short of the important aspects of emotions. He tells us that, “Emotions…amplify memories,” but this sidesteps a discussion of the amazing feeling that nostalgia brings. I know that emotions are probably one of the most interesting things to study about the mind. This is because they present the greatest mystery. But personally, I rather think that mystery is what makes life interesting, and I wouldn’t want to solve this one even if I could.

Lyde Sizer speaks in-depth about the need for contact that all of her children—including Ryland, her autistic son—share. This would seem to go against most definitions of autism. So here I am, fuzzier than when I began. Here, her child clearly shows a need for physical contact, which implies a certain amount of emotional response in a child who, by nature of his condition, should not really be driven to such personal interactions. I suppose we must come to understand that individualism is no less prevalent simply because a child is on the autistic spectrum. Humans have a bent for uniqueness that no syndrome could take away. We are all so different in subtle ways that it seems to me that even our idea of a “spectrum” for autism is flawed. Someone could fall in one place mentally, in terms of IQ, and then another place entirely in terms of how well they interact with people. Should we accept some arbitrary quantization of terms into an aggregate total? Or should we rather love and respect people for who they are?

The issues explored involving emotions are issues that we all deal with, autistic or not. They are issues of opening up, letting go, feeling relaxed in our own bodies. In reading the Developmental Psychology article that was assigned, a curious question came into my head: Do autistic children really have more trouble coming up with an introspective response, or are “typically developing” children just better at making something up? The main difference between the two types of children seemed to be that typically developing children were more prone to telling stories. This simply made my mind jump back to our discussion of confabulation. Do we really know what we feel any better than an autistic person does? Or do we pretend we know? Do we tell a story, finding our feelings only after the story has been told? Emotions are more than words. So, is a measure of our ability to give words to our emotions really an accurate measure of whether we have complex emotions? I would say no.